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Thighbone (Femur) Fractures In Children Page ( 1 )

The thighbone (femur) is the largest and strongest bone in the body. It can break
when a child experiences a sudden forceful impact.

Cause

Statistics
The most common cause of thighbone fractures in infants under 1 year old is
child abuse. Child abuse is also a leading cause of thighbone fracture in children
between the ages of 1 and 4 years, but the incidence is much less in this age group.

In adolescents, motor vehicle accidents (either in cars, bicycles, or as a pedestrian)

are responsible for the vast majority of femoral shaft fractures.

Risk
Events with the highest risk for pediatric femur fractures include:
• Falling hard on the playground
• Taking a hit in contact sports
• Being in a motor vehicle accident
• Child abuse

Types of Femur Fractures (Classification)

Femur fractures vary greatly. The pieces of bone may be aligned correctly (straight)
or out of alignment (displaced), and the fracture may be closed (skin intact) or open
(bone piercing through the skin). An open fracture is rare.

Specifically, thighbone fractures are classified depending on:

• Location of fracture on the bone (proximal, middle, or distal third of the bone
shaft)
• Shape of the fractured ends — bones can break all kinds of ways, such as
straight across (transverse), angled (oblique), or spiraled (spiral)
• Position of the fractured edges (angulated or displaced)
• Number of fractured parts Types of femur fractures. (Left) An
o Two parts oblique, displaced fracture of the
femur shaft. (Right) A comminuted
o Several fractured parts (comminuted) fracture of the femur shaft.

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not
intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your
area through the AAOS “Find an Orthopaedist” program on OrthoInfo.org.
Copyright ©1995-2015 by the American Academy of Orthopaedic Surgeons.
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Thighbone (Femur) Fractures in Children cont. Page ( 2 )

Symptoms

A thighbone fracture is a serious injury. It may be obvious that the thighbone is

fractured because:
• Your child has severe pain
• The thigh is noticeably swollen or deformed
• Your child is unable to stand or walk, and/or
• There is a limited range of motion of the hip or knee allowed by the child
because of pain.
Take your child to the emergency room right away if you think he or she has a
broken thighbone.

Doctor Examination

It is important that the doctor know exactly how the injury occurred. Tell the doctor
if your child had any disease or other trauma before it happened.

The doctor will give your child pain relief medication and carefully examine the
leg, including the hip and knee. A child with a thighbone fracture should always be
evaluated for other serious injuries.

Imaging Tests
Your orthopaedic doctor will need x-rays to see what the broken bone looks
like (refer to “Classification”). Your child’s healthy leg may also be x-rayed for
comparison.

The orthopaedic doctor will also check the x-ray for any damage to the growth area
(growth plate) near the end of the femur. This is the part that enables the child’s
bone to grow. If needed, surgery may help to restore the growth plate’s function,
and regular x-rays may be taken for many months to track the bone’s growth.

Treatment

To treat a child’s thighbone fracture, the pieces of bone are realigned and held in
place for healing. Treatment depends on many factors, such as your child’s age and
weight, the type of fracture, how the injury happened, and whether the broken A young child in a hip spica
bone pierced the skin. cast to immobilize a femoral
shaft fracture.
Nonsurgical Treatment Courtesy of Texas Scottish
In some thighbone fractures, the doctor may be able to manipulate the broken Rite Hospital
bones back into place without an operation (closed reduction). In a baby under 6

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not
intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your
area through the AAOS “Find an Orthopaedist” program on OrthoInfo.org.
Copyright ©1995-2015 by the American Academy of Orthopaedic Surgeons.
 .org

Thighbone (Femur) Fractures in Children cont. Page ( 3 )

months old, a brace (called a Pavlik Harness) may be able to hold the broken bone
still enough for successful healing.

Spica casting. In children between 7 months and 5 years old, a spica cast is often
applied to keep the fractured pieces in correct position until the bone is healed.

There are different types of spica casts, but, in general, a spica cast begins at the
chest and extends all the way down the fractured leg. The cast may also extend
down the uninjured leg, or stop at the knee or hip. Your doctor will decide which
type of spica cast is most effective for treating your child’s fracture.

Your doctor will sedate your child for the closed reduction, and apply a spica cast
immediately (or within 24 hours of hospitalization) to keep the fractured pieces in
correct position until healing occurs.
A thighbone fracture before and
When a bone breaks and is displaced, the pieces often overlap and shorten the immediately after treatment with a
normal length of the bone. Because children’s bones grow quickly, your doctor may spica cast. The femur will remodel
not need to manipulate the pieces back into perfect alignment. While in the cast, over time so that it appears normal.
the bones will grow and heal back into a more normal shape.

In general, for the best results, the broken pieces should not overlap more than 2
cm when in the cast. The growth of the thighbone may be temporarily increased by
the trauma. The mild shortening from the overlap will resolve.

Traction. If the shortening of the bones is too much (more than 3 cm) or if the
bone is too crooked in the cast, it may be helpful to put the leg in a weight and
counterweight system (traction) to make sure the bones are properly realigned.

Surgical Treatment
Doctors generally agree that displaced femur fractures that have shortened more
than 3 cm are not acceptable and require treatment to correct at least a portion of
the shortening.

In some more complicated injuries, the doctor may need to surgically realign the
bone and use an implant to stabilize the fracture.

Doctors are treating pediatric thighbone fractures more often with surgery than in
previous years due to the benefits that have been recognized. These include earlier (Left) Preoperative X-ray of a child
with a fracture through the midshaft
mobilization, faster rehabilitation, and shorter time spent in the hospital. of the left femur. (Right) Postoperative
X-ray of the same child shows that
In children between 6 and 10 years old, flexible intramedullary (inside the bone) the fracture was treated with internal
nails are often used to stabilize the fracture. Over the past decade, this treatment flexible nailing to restore stability and
method has gained great acceptance. allow early mobilization.

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not
intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your
area through the AAOS “Find an Orthopaedist” program on OrthoInfo.org.
Copyright ©1995-2015 by the American Academy of Orthopaedic Surgeons.
 .org

Thighbone (Femur) Fractures in Children cont. Page ( 4 )

Occasionally, the broken bone has too many pieces and cannot be treated
successfully with flexible nails. Other options that can lead to successful outcomes
in this situation include:

• A plate with screws that “bridges” the fractured segments

• An external fixator — this is often used if there has been a large open injury to
the skin and muscles
• Prolonged traction with a pin temporarily placed into the thighbone

As the child nears the teenage years (11 years to skeletal maturity), the most
common treatment choices include either flexible intramedullary nails or a rigid
locked intramedullary nail. The rigid nail is particularly useful when the fracture is
unstable. Both types of nails allow for the child to begin walking immediately.
External fixation is often used to hold
the bones together when the skin and
Long-Term Outcomes muscles have been injured.
Generally, children who sustain a thighbone fracture will heal well, regain normal
function, and have legs that are equal in length. The intramedullary nails may need
to be removed following healing if they cause irritation of the skin and tissues
underneath.

Occasionally, children will require further treatment, either early on or in

subsequent years, if they have a significant difference in the length of the legs,
unacceptable angulation of the healed bone, abnormal rotation of the healed bone,
infection, or (rarely) if a thighbone fracture persists (nonunion).

These problems can nearly always be resolved with further treatment.

AAOS Guideline for the Treatment of Pediatric Thighbone Fractures

In order to assist doctors in the treatment of thighbone fractures, the American
Academy of Orthopaedic Surgeons has done research to provide some useful
guidelines. These are recommendations only and may not apply to each and every
individual case. A rigid, locked intramedullary nail
is often used for femur fractures in
See Guideline on the Treatment of Pediatric Diaphyseal Femur Fractures online at adolescents who are nearly full grown.
http://www.aaos.org/research/guidelines/PDFFguideline.asp

Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America)

OrthoInfo.org provides expert information about a wide range of musculoskeletal

conditions and injuries. All articles are developed by orthopaedic surgeons who are
members of the American Academy of Orthopaedic Surgeons (AAOS). To learn more
about your orthopaedic health, please visit orthoinfo.org.

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not
intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your
area through the AAOS “Find an Orthopaedist” program on OrthoInfo.org.
Copyright ©1995-2015 by the American Academy of Orthopaedic Surgeons.